The Gap Between What Parents Need and How Pediatric Primary Care Providers Can Help Families of Children With Special Education Needs.

We describe the gap between parents' special education needs and pediatric primary care providers' (PCPs) ability to address those needs from a mixed-methods study at a safety-net hospital. We conducted qualitative interviews with English- and Spanish-speaking parents (n = 25) and PCPs (n = 11) about special education knowledge and experience and interactions with a primary care-embedded special education clinic. PCPs also answered survey questions on these topics. Parents reported four challenges: (1) knowing where to start and how to advocate for their youth, (2) being heard or having a say, (3) using the "right" language, and (4) gathering information on special education resources. Primary care providers disclosed three barriers: (1) training, (2) knowledge to assess the appropriateness of supports, and (3) time to address concerns. The gap between PCPs and parents was bridged by the special education clinic. Systematic interventions can ensure that PCPs help parents address the special education needs of their patients.

Research activity, facilitators and barriers amongst trainee and early-career family physicians in sub-Saharan Africa: A cross-sectional survey.

BACKGROUND:  Primary health care systems in sub-Saharan Africa (SSA) need context-specific evidence to address current challenges. Increased family physician (FP) research activity could help fill this gap. AIM:  To describe the research activity, facilitators and barriers amongst AfriWon Renaissance members. SETTING:  An online programme was designed to improve research activity amongst members of AfriWon Renaissance, an organisation of early-career and trainee FPs in SSA. This article provides a baseline description of their research activity. METHODS:  All AfriWon Renaissance members were invited to participate in an online survey. A content-validated study tool assessed research activity, including participation in research meetings, engagement in research mentorship, number of projects and published articles. Facilitators and barriers were assessed via Likert scales and two open-ended questions. The researchers conducted descriptive statistics using Epi Info 7, a content analysis of open-ended responses and triangulation. RESULTS:  Amongst the 77 respondents, 49 (63.6%) were still in training. Over two-thirds (71.4%) had participated in a research discussion in the past month. Whilst more than half (63.5%) reported having a manuscript under development, only 26 (33.8%) reported a recent publication. Nearly all (94.8%) intend to continue research in their FP careers. The most common facilitators were the institutional requirement to conduct research and having supportive peers and mentors. The most predominant barriers were time constraints and a lack of training on analysis. CONCLUSION:  There is a cohort of committed young FP researchers who would benefit from efforts to address identified barriers and support for their ongoing research activity, in order to increase primary care research outputs in SSA.

Governance systems for skilled health worker migration, their public value and competing priorities: an interpretive scoping review.

BACKGROUND: Governments worldwide participate in skilled health worker (SHW) migration agreements to protect access to health services in their countries. Previous studies have described the value offered by these agreements in separate source and destination country perspectives. OBJECTIVE: We sought to identify and summarise existing literature on shared value creation for both source and destination countries. METHOD: We conducted a systematic scoping review of health databases and grey literature. Using Mark Moore and Colin Talbot frameworks, we summarised the public value propositions in migration agreements and how state actors addressed competing priorities. RESULTS: Most articles (34/63, 53.9%) reported transnational SHW mobility as the public value proposition for source and destination countries. Fewer articles, 14 (22.2%) and 9 (14.3%) articles, respectively, referred to achieving health workforce sustainability and building capacity for SHW migration governance as shared public values. The most identified competing public value (CPV) was an overriding focus on addressing SHW shortages in destination countries (20/63, 37.7%). Efforts to address this CPV include mitigation of the adverse effects of migration (43/63, 68.3%) and promoting health workforce development in source countries (15, 23.8%). At the same time, state actors retained regulatory discretion for protecting their country's public health interest (34, 54%). Most articles reported the lack of funds (15/63, 23.8%) and implementation mechanisms (19/63, 30.2%) as constraints on the authorising environment and the operational capacity of SHW migration governance systems. CONCLUSION: Regarding SHW migration governance, the literature reports shared public value propositions for source and destination countries. It also shows how the value-creating process in the management of SHW migration favours destination countries. Future studies will need to explore shared value creation models that ensure equity in the governance of SHW migration.

Implementation of Online Research Training and Mentorship for Sub-Saharan African Family Physicians.

Background: To improve the delivery and reach of primary health care, a robust scientific foundation driven by research is needed. However, few family physicians conduct research, especially in sub-Saharan Africa. Early-career and trainee family physicians are a key part of the primary care research pipeline and have an expressed need for research training and mentorship. Objective: AfriWon Research Collaborative (ARC) was an online research training and mentorship pilot program whose objective was to increase research activity among participants from AfriWon Renaissance, the family physician young doctors' movement of sub-Saharan Africa. Methods: ARC utilized a 10-module online curriculum, supported by peer and faculty e-mentorship, to guide participants through writing a research protocol. The feasibility, acceptability, and scalability of this program was evaluated via a mixed-methods RE-AIM-guided process evaluation using descriptive statistics and inductive/deductive thematic analysis. Findings: The pilot reached participants from Botswana, Democratic Republic of the Congo, Ghana, Nigeria and Sierra Leone and was adopted by mentors from 11 countries across three continents. Four of the 10 pilot participants completed a full research protocol by the end of the six-month core program. Seven out of the 10 participants, and nine out of the 15 mentors, planned to continue their mentorship relationships beyond the core program. The program helped instill a positive research culture in active participants. Some participants' and mentors' engagement with the ARC program was limited by confusion over mentorship structure and role, poor network connectivity, and personal life challenges. Conclusions: Online research training and mentorship for trainee and early-career family physicians in sub-Saharan Africa is feasible and acceptable to participants and mentors. Similar programs must pay careful attention to mentorship training and provide a flexible yet clearly organized structure for mentee-mentor engagement. Additional work is needed to determine optimal implementation strategies and ability to scale.